Evaluación de lenalidomida en el tratamiento del mieloma múltiple, la mielofibrosis y el síndrome mielodisplásico / Assessing lenalidomide for treating multiple myeloma, myelofibrosis and myelodysplastic syndrome

Objetivo La lenalidomida (LDM) es un agente inmunomodulador y antiangiogénico que ha demostrado su eficacia en varios trastornos hematológicos (mieloma múltiple [MM], metaplasma mieloide con mielofibrosis [MF] y síndrome mielodisplásico [SMD]). El objetivo de este estudio fue evaluar la efectividad y la tolerabilidad de la LDM en nuestros pacientes. Método Estudio retrospectivo observacional que incluyó a los pacientes de nuestro hospital en seguimiento por la consulta de Hematología que fueron diagnosticados de MM, MF y SMD, y que eran candidatos a recibir tratamiento con LDM. La evaluación de la eficacia se realizó transcurridos aproximadamente 4 ciclos desde el inicio del tratamiento. Resultados Desde febrero de 2007 hasta marzo de 2008 fueron 16 los pacientes candidatos a recibir tratamiento con LDM (50% mujeres, 50% varones, con una edad media de 69,6 años), aunque 3 de ellos no llegaron a iniciarlo. De los 6 pacientes con MM tratados en nuestro hospital, 5 de ellos obtuvieron algún tipo de respuesta (83,3%). De los 4 pacientes con MF, 2 (66,6%) experimentaron algún tipo de respuesta al tratamiento. De los 6 pacientes diagnosticados de SMD, únicamente se inició el tratamiento en 3, y en 2 de ellos se tuvo que suspender por distintas causas. Destacamos que únicamente hubo que suspender el tratamiento en dos de los 13 pacientes que lo iniciaron (15,4%) por los efectos adversos. Conclusión La LDM consigue, con buena tolerancia, beneficio clínico mantenido sobre todo en el MM y la MF. Son necesarios más estudios que profundicen en la duración del tratamiento, en nuevas indicaciones y en el uso de tratamientos combinados con otros agentes (AU)

Objective Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients. Method Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment. Results Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE).Conclusion LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs (AU)

[Assessing lenalidomide for treating multiple myeloma, myelofibrosis and myelodysplastic syndrome]. / Evaluación de lenalidomida en el tratamiento del mieloma múltiple, la mielofibrosis y el síndrome mielodisplásico.

OBJECTIVE: Lenalidomide (LDM) is an immunomodulatory and anti-angiogenic drug which has been shown to be effective in several haematological disorders (multiple myeloma [MM], myeloid metaplasia with myelofibrosis [MF] and myelodysplastic syndrome [MDS]). The objective of this study is to evaluate the effectiveness and tolerability of LDM in our patients. METHOD: Retrospective observational study which included patients at our hospital who were monitored by the haematology unit, diagnosed with MM, MF and MDS and candidates for LDM treatment. Treatment effectiveness was assessed after approximately 4 cycles of treatment. RESULTS: Between February 2007 and March 2008, 16 patients were listed as candidates for receiving treatment with LDM (50% female/50% male, with a mean age of 69.6 years); of these candidates, 3 never initiated treatment. Five of the six patients with MM treated at our hospital obtained some sort of response (83.3%). Of the 4 patients with MF, 2 (66.6%) experienced some sort of response to treatment. Of the 6 patients diagnosed with MDS, treatment was initiated in 3, and it had to be suspended in 2 cases due to different reasons. Treatment only had to be suspended in two of the 13 patients who began it (15.4%) due to adverse effects (AE). CONCLUSION: LDM is well-tolerated and produces sustained clinical benefits, especially in MM and MF. More studies are needed for in-depth examination of treatment duration, new indications and the use of treatments combined with other drugs.

Ingresos hospitalarios por ingesta accidental de medicamentos y productos tóxicos en pediatría. Hospital General de Requena (1997-2004) / No disponible

Objetivos: Estudio de la incidencia de intoxicaciones accidentales en la infancia, motivo de consulta en el servicio de urgencias del hospital para implementación de medidas preventivas. Diseño: Retrospectivo, descriptivo. Emplazamiento: Hospital comarcal, ámbito rural. Participantes: Pacientes en edad pediátrica cuyo motivo de consulta fue ingesta accidental de medicamentos o productos tóxicos. Medidas e intervenciones: Análisis del episodio asistencial recogiendo edad, género, naturaleza del producto ingerido, fecha, época del año en la que se produjo el accidente. Promover medidas de prevención mediante charlas divulgativas a determinados grupos sociales y en colaboración con profesionales sanitarios de Atención Primaria. Resultados: En el periodo 1997-2004 fueron tratados en el Servicio de Urgencias del hospital 76 casos de ingesta accidental de medicamentos o productos tóxicos por niños. El 47,4% (36 casos) por ingesta de medicamentos, el 36,8% (28 casos) por ingesta de productos de limpieza, y el 15,7% restante (12 casos) por productos varios. En 19 casos (25% del total de casos), se produjo por la ingesta de la propia medicación del niño, estando implicado el paracetamol solución en 13 de éstos (17% del total de casos). En 17 ocasiones la medicación ingerida pertenecía a un familiar adulto. La ingesta de lejía fue la causa en 13 de los 28 casos ocasionados por productos de limpieza. El 85,5% de los casos se produjo en el rango de edad de 1 a 3 años. El 17% ocasionó ingreso hospitalario superior a 24 horas. Conclusión: La ingesta accidental en niños de medicamentos y productos domésticos es un problema cotidiano. Se proponen como medidas preventivas, campañas de información a la población general a través de los profesionales sanitarios de atención primaria. También consideramos muy importante la implicación de la industria farmacéutica para que adopte medidas en el cambio de la presentación de sus envases y así disminuir dicho problema (AU)

Objective: The study of the incidence of accidental poisoning in children as the reason for visits to the hospital emergency service, for the implementation of preventive measures. Design: A retrospective descriptive study. Site: A regional hospital in a rural setting. Participants: Pediatric patients brought to the hospital after accidental ingestion of medications or toxic products. Measurements and interventions: Analysis of each episode, recording the age and sex of the child, type of product ingested and the date and season of the year in which the accident took place. Promotion of preventive measures through informative talks to certain social groups, in collaboration with primary health care professionals. Results: Between 1997 and 2004, 76 cases of accidental ingestion of medications or toxic products by children were treated in our emergency service. Thirty-six of the children (47.4%) had taken some type of medication, 28 (36.8%) had swallowed cleaning products and the remaining 12 (15.7%) had ingested some other toxic product. In 19 cases, (25% of the entire population), the cause was the child’s own medicine, involving a paracetamol solution in 13 cases (17% of the entire population). In 17 cases, the medication ingested was that of an adult relative. Bleach was the cause in 13 of the 28 cases in which cleaning products had been ingested. In all, 85.5% of the incidents involved children between the ages of 1 and 4 years, and a hospital stay of more than 24 hours was required in 17%. Conclusion: The accidental ingestion of medications and household products is an everyday problem. The preventive measures proposed include public information campaigns involving the primary health care professionals. We also consider it to be highly important that the drug industry become implicated, making changes in the packaging and, thus, helping to reduce the problem (AU)

[Role of allopurinol and rofecoxib in agranulocytosis and acute tubular necrosis]. / Implicación de alopurinol y rofecoxib en agranulocitosis y necrosis tubular aguda.

OBJECTIVE: To report the case of a patient who developed a life-threatening agranulocytosis and acute tubular necrosis after the administration of allopurinol and rofecoxib. CASE REPORT: After minor surgery, a 70-year-old male underwent a routine blood test which encountered: anemia, leucopenia, neutropenia, thrombopenia, and altered creatinine levels. Both marrow and renal biopsies were performed, yielding the following results: acute tubular necrosis and agranulocytosis in the recovery stage. One month and a half before the aforementioned surgery a routine blood test had been performed, which showed normal values. The patient had then received allopurinol 100 mg/day for around 2 months, and rofecoxib 2.5 mg/day for 14 days. DISCUSSION: After ruling out other possible causes, a diagnosis of iatrogenically induced agranulocytosis and acute tubular necrosis was reached. We used a (modified) Karch-Lasagna algorithm with both drugs, and found the following imputability values: possible for rofecoxib and probable for allopurinol. In view of the widespread use of rofecoxib and COX-2 inhibitors, despite their recent availability, and of their potential role in the severe adverse effects discussed, healthcare professionals must be on the alert for the development of symptoms suggesting said or other adverse effects.

Implicación de alopurinol y rofecoxib en agranulocitosis y necrosis tubular aguda / Role of allopurinol and rofecoxib in agranulocytosis and acute tubular necrosis

Objetivo: Describir el caso de un paciente que desarrolló una agranulocitosis y una necrosis tubular aguda que comprometió su vida tras la administración de alopurinol y rofecoxib. Descripción del caso: Varón de 70 años, al que se le realizó una analítica de control tras una intervención menor, observándose anemia, leucopenia, neutropenia, trombopenia y alteración de los niveles de creatinina. Se efectuó biopsia renal y medular con el resultado de necrosis tubular aguda y médula compatible con agranulocitosis en fase de recuperación. Mes y medio antes de la intervención indicada se le había realizado una analítica de control encontrando valores dentro de la normalidad. Anteriormente el paciente había iniciado tratamiento con alopurinol 100 mg al día durante aproximadamente 2 meses, y rofecoxib 2,5 mg al día durante 14 días. Comentario: Tras descartar otras posibles causas, se llegó al diagnóstico de agranulocitosis y necrosis tubular aguda de origen iatrogénico. Aplicamos el algoritmo de Karsch-Lasagna (modificado) para ambos fármacos, encontrando los siguientes valores de imputabilidad: posible para el rofecoxib y probable para el alopurinol. Debido al amplio uso de rofecoxib y los inhibidores de la COX-2, a pesar de su reciente comercialización, y su posible implicación en los graves efectos adversos descritos, los profesionales sanitarios deben estar alertados ante la aparición de síntomas que puedan hacer sospechar la aparición de éstos u otros efectos adversos (AU)